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What Is Depression?

Depression has a variety of symptoms, but the most common is a deep feeling of sadness. People with depression may feel tired, listless, hopeless, helpless, and generally overwhelmed by life. Simple pleasures are no longer enjoyed, and their world can appear dark and uncontrollable. Emotional and physical withdrawal are common responses of depressed people.

Depression can strike at any time, but most often appears for the first time during the prime of life, from ages 24 to 44. One in four women and one in 10 men will confront depression at some point in their lives. Symptoms of Depression

Depression is diagnosed if a person experiences (1) persistent feelings of sadness or anxiety or (2) loss of interest or pleasure in usual activities in addition to five or more of the following symptoms for at least 2 consecutive weeks.

  • Changes in appetite that result in weight losses or gains not related to dieting
  • Insomnia or oversleeping
  • Loss of energy or increased fatigue
  • Restlessness or irritability
  • Feelings of worthlessness or inappropriate guilt
  • Difficulty thinking, concentrating, or making decisions
  • Thoughts of death or suicide or attempts at suicide

Depression is diagnosed only if the above symptoms are not due to other conditions (e.g., neurological or hormonal problems) or illnesses (e.g., cancer, heart attack) and are not the unexpected side effects of medications or substance abuse.

What Causes Depression?

Several factors play a role in the onset of depression.

Biochemistry. Deficiencies in two chemicals in the brain, serotonin and norepinephrine, are thought to be responsible for certain symptoms of depression, including anxiety, irritability, and fatigue.

Genetics. Depression can run in families. For example, if one identical twin has depression, the other twin has a 70% chance of also having the illness sometime in life.

Personality. People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be vulnerable to depression.

Environmental factors. Continuous exposure to violence, neglect, abuse, or poverty may make people who are already susceptible to depression all the more vulnerable to the illness.

However, it should be noted that depression can still occur under ideal living circumstances.

How Is Depression Treated?

Unfortunately, depression cannot be controlled for any length of time simply through exercise, through changes in diet, or by taking a vacation. But it is among the most treatable of mental disorders. Between 80% and 90% of people with depression respond well to treatment, and almost all patients gain some relief from their symptoms.

Before a specific treatment is recommended, a psychiatrist will conduct a thorough diagnostic evaluation, consisting of an interview and a physical examination. Its purpose is to reveal specific symptoms, medical and family history, cultural setting, and environmental causes of stress to arrive at a proper diagnosis and to determine the best treatment.

Medication

Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain. These medications are not sedatives, "uppers," or tranquilizers; they are not habit-forming; and they generally have no stimulating effect on people not experiencing depression.

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications-chiefly the selective serotonin reuptake inhibitors (SSRIs)-the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The SSRIs-and other newer medications that affect neurotransmitters such as dopamine or norepinephrine-generally have fewer side effects than tricyclics. Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of medications. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects (see section on Side Effects, page 13) may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust, and many can produce withdrawal symptoms if discontinued abruptly. For individuals with bipolar disorder and those with chronic or recurrent major depression, medication may have to be maintained indefinitely.

Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.

For the small number of people for whom MAO inhibitors are the best treatment, it is necessary to avoid certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a hypertensive crisis, a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the patient should carry at all times. Other forms of antidepressants require no food restrictions.

Medications of any kind - prescribed, over-the counter, or borrowed - should never be mixed without consulting the doctor. Other health professionals who may prescribe a drug-such as a dentist or other medical specialist-should be told of the medications the patient is taking. Some drugs, although safe when taken alone can, if taken with others, cause severe and dangerous side effects. Some drugs, like alcohol or street drugs, may reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor. Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants.

Side Effects

Antidepressants may cause mild and, usually, temporary side effects (sometimes referred to as adverse effects) in some people. Typically these are annoying, but not serious. However, any unusual reactions or side effects or those that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are:

  • Dry mouth ­ it is helpful to drink sips of water; chew sugarless gum; clean teeth daily.
  • Constipation ­ bran cereals, prunes, fruit, and vegetables should be in the diet.
  • Bladder problems ­ emptying the bladder may be trouble-some, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty or pain.
  • Sexual problems ­ sexual functioning may change; if worrisome, it should be discussed with the doctor.
  • Blurred vision ­ this will pass soon and will not usually necessitate new glasses.
  • Dizziness ­ rising from the bed or chair slowly is helpful.

Drowsiness as a daytime problem ­ this usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

The newer antidepressants have different types of side effects:

  • Headache ­ this will usually go away.
  • Nausea ­ this is also temporary, but even when it occurs, it is transient after each dose.
  • Nervousness and insomnia (trouble falling asleep or waking often during the night) ­ these may occur during the first few weeks; dosage reductions or time will usually resolve them.
  • Agitation (feeling jittery) ­ if this happens for the first time after the drug is taken and is more than transient, the doctor should be notified.
  • Sexual problems ­ the doctor should be consulted if the problem is persistent or worrisome.

Psychotherapy

Psychotherapy, or "talk therapy," may be used either alone for treatment of mild depression or in combination with antidepressant medications for moderate to severe depression.

Psychotherapy can involve only the individual patient or include others. Family or couples therapy helps to address specific issues that can arise within these close relationships. Group therapy involves people with similar illnesses. Depending on the severity of the depression, treatment can take a few weeks or substantially longer. However, in many cases, significant improvement can be made in 10-15 sessions.

Depression is never normal and always produces needless suffering. With proper diagnosis and treatment, depression can be overcome in the vast majority of people. If you are experiencing symptoms of depression, see your physician or psychiatrist, describe your concerns, and request a thorough evaluation. You will feel better.

How to Help Yourself

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that may make you feel better.
  • Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
  • Expect your mood to improve gradually, not immediately. Feeling better takes time.
  • It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition-change jobs, get married or divorced-discuss it with others who know you well and have a more objective view of your situation.
  • People rarely "snap out of" a depression. But they can feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
  • Let your family and friends help you.

Depression in Women

Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women-particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

A recent NIMH study showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects of the hormonal manipulation.

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient "blues" are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic physician and the family's emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being and her ability to care for and enjoy the infant.

Other Sources of Information

National Depression Screening Day
For FREE depression screening in your community
800-573-4433.

Depression Awareness Recognition & Treatment (D/ART)
5600 Fishers Lane, Room 14C03
Parklawn Building
Rockville, MD 20857
301-443-4140
www.nimh.nih.gov/DART/index.htm

NAMI (National Alliance for the Mentally Ill)
Colonial Place Three
2107 Wilson Blvd. - Suite 300
(703) 524-7600
(703) 524-9094 (fax)
NAMI HelpLine: 1-800-950-NAMI (6264)
www.nami.org

National Depressive and Manic-Depressive Association
730 N. Franklin, #501
Chicago, IL 60610
312-642-0049
www.ndmda.org

National Foundation for Depressive Disorders
P.O. Box 2257
New York, NY 10016
800-248-4344

National Institute of Mental Health Information Resources and Inquiries Branch
5600 Fishers Lane, Room 7C02
Rockville, MD 20857
301-443-4513
www.nimh.nih.gov

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
703-684-7722
www.nmha.org
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